title: The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates.
abstract: OBJECTIVE
  Although various surveys have tracked the prevalence of anabolic-androgenic steroid (AAS) use in American teenagers and young adults, no recent surveys have assessed the lifetime prevalence of AAS use in Americans overall. We therefore analyzed serial youth-survey data to derive estimates of the lifetime prevalence of AAS use in the current American general population.
  
  
  METHODS
  We first determined the distribution of age of onset of AAS use, based on pooled data from nine studies. Using this distribution, we then developed equations to project the eventual lifetime prevalence of AAS use among young survey respondents, once they aged and completed the period of risk for initiating AAS. We similarly calculated the denominator of lifetimes of risk for AAS use in the total American population. We next applied these equations to four independent national youth datasets to derive current American general-population estimates for lifetime AAS use. Finally, using data from 10 pooled studies, we estimated the lifetime prevalence of AAS dependence among AAS users.
  
  
  RESULTS
  Age-of-onset studies consistently showed that AAS use begins later than most drugs, with only 22% of users (95% confidence interval: 19-25%) starting before age 20. Applying the age-of-onset findings to national youth datasets, we estimated that among Americans currently age 13-50 years, 2.9-4.0 million have used AAS. Within this group, roughly 1 million may have experienced AAS dependence.
  
  
  CONCLUSIONS
  Although subject to various limitations, our estimation techniques suggest a surprisinigly high prevalence of AAS use and dependence among Americans.
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Harrison G
authors.initials: HG
authors.lastname: Pope
authors.forename: Gen
authors.initials: G
authors.lastname: Kanayama
authors.forename: Alison
authors.initials: A
authors.lastname: Athey
authors.forename: Erin
authors.initials: E
authors.lastname: Ryan
authors.forename: James I
authors.initials: JI
authors.lastname: Hudson
authors.forename: Aaron
authors.initials: A
authors.lastname: Baggish
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D045930:Anabolic Agents / Q000009:adverse effects*; D000728:Androgens / Q000009:adverse effects*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D000728:Androgens